Kayla Bussey
Covington
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
9
9
years of professional experience
Work History
MEDICARE PART D REP
CVS
03.2024 - Current
- Contacted insurance companies to obtain prior authorization for medical procedures and medications.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Communicated pertinent information to client's prescribing provider to facilitate quality service.
- Tracked referral submission during facilitation of prior authorization issuance.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Created and maintained spreadsheets detailing medical procedures and insurance denials and approvals.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
Insurance Claims Specialist
Nationwide
04.2022 - 03.2024
- Followed up with customers on unresolved issues.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Processed and recorded new policies and claims.
- Checked documentation for accuracy and validity on updated systems.
- Supported customer questions and issues by gathering data, analyzing needs, evaluating possible resolutions and implementing best solutions.
- Recommended solutions to complex situations through research and critical thinking and escalated customer to supervisor for enhanced support.
- Contributed ideas and practical solutions to support process improvement efforts.
- Shared strategic insights with interdepartmental teams regarding customer experience and service-related trends to improve service delivery.
- Resolved customer complaints by distinguishing, prioritizing and reporting technical issues.
Quality Assurance Specialist
Next Level
12.2021 - 04.2022
- Educated employees on specific QA standards and confirmed maintenance of standards.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- Monitored product standards and quality-control programs.
- Completed deviation forms and recorded findings of inspection process, collaborating with department managers to implement procedural remedies.
- Kept inspection journals and daily summary logs as required.
- Listen to recorded calls
- Grade calls according to Client rubric
- Provide results to supervisors
- Identify coaching opportunities for individual team members
- File and organize QA scorecards
- QA data entry
- Provided training to over 6 onboarding team members in 2 year
Customer Support Representative
Next Level
10.2016 - 02.2021
- Delivered service and support to each customer, paving way for future business opportunities.
- Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Applied good listening skills to determine customer preferences and financial limits.
- Built trust and loyalty by maintaining professionalism while persuading customers.
- Placed orders and answered customer questions in-person, through email and over phone to maximize customer service.
- Displayed strong telephone etiquette, effectively handling difficult calls.
Education
General High School Diploma -
Provost Academy High School
05.2015
Skills
- Attention to Detail
- Active Listening Skills
- Salesforce software experience
- Managing groups of 25 Customer service reps
- Shopify/Zendesk software experience
- ADP software Experience
- Kronos Software Experience
- Improving Customer Experience
- Building Customer Loyalty
- Quality Assurance Data Entry
- Positive Attitude
- Management and Training
- Time Management
- Interpersonal Skills
- Customer service training and mentoring
Timeline
MEDICARE PART D REP
CVS
03.2024 - Current
Insurance Claims Specialist
Nationwide
04.2022 - 03.2024
Quality Assurance Specialist
Next Level
12.2021 - 04.2022
Customer Support Representative
Next Level
10.2016 - 02.2021
General High School Diploma -
Provost Academy High School
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